Background

Financial disincentives remain a major barrier to increasing rates of living kidney donation. A recent study found that 96% of living kidney donors (LKD) reported a mean of $523 direct costs during the evaluation process (Rodrigue, 2015). There is limited research on the costs LKDs acquire during the peri-operative period.

Methods

We conducted a longitudinal, prospective study of adults undergoing LKD evaluation at 3 centers. This abstract reports a subset of the data for participants who became LKDs, collected two weeks prior to their scheduled surgery date. LKDs completed interviews and demographic surveys. Transcripts were analyzed inductively for themes about experienced and expected financial difficulties, as well as planned coping mechanisms.

Results

The cohort included 48 LKDs (response rate 94%). Most were white (83%), female (67%), married (75%), employed (75%), had some college education (73%); 37% had an income of >$100,000/year.

Many LKDs (42%) reported experiencing financial difficulty from donor evaluation; a third of these indicated that this was a significant burden. One-fourth described financial inconveniences related to taking time off work: “I'm losing out on making money.” Travel expenses were particularly burdensome (21%): “It's been pretty cost prohibitive flying back and forth.” Some LKDs (19%) complained about parking fees and other small expenses.

Nineteen percent of LKDs expected to experience financial difficulties as a result of donation. Another 28% of LKDs took precautionary measures to avoid financial difficulties during the post-donation recovery period, including saving money (17%), working overtime (10%), and other strategies such as fundraising (8%): “I've been almost tripling my work load the last 3 weeks.” LKDs who were divorced or never married (compared to married LKDs, 50% vs. 8%, p=0.0047) and those who earned <$65,000 (compared to those making >$65,000, 43% vs 10%, p=0.015) were more likely to expect donation-related financial difficulties.

Conclusion

Two-fifths of LKDs experienced financial difficulties during evaluation and one-fifth anticipated post-operative financial difficulties. Another third engaged in long-term planning to cover donation-related costs. Our results may help transplant centers to prospectively identify LKDs who are in greatest need of financial assistance as well as strategies to mitigate the financial burden of donation.

CITATION INFORMATION: Li S, Thiessen C, Gannon J, Dobosz D, Gray D, Mussell A, Kennedy K, Reese P, Gordon E, Kulkarni S. Financial Burdens and Coping Mechanisms of Living Kidney Donors. Am J Transplant. 2016;16 (suppl 3).

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